Codeine/Chlorpheniramine/Pseudoephedrine

DEA Class; Rx

Common Brand Names; Dihistine DH, Zodryl DAC Liquid, Ryna-C

Codeine: Narcotic agonist analgesic with antitussive activity, mu receptor agonist

Chlorpheniramine: Histamine H1-receptor antagonist

Pseudoephedrine: Sympathomimetic; alpha adrenergic agonist

Indicated for Allergic Rhinitis, Cough, Sinus Congestion

Codeine

• Absolute: acute abdominal condition, diarrhea associated with toxins, pseudomembranous colitis, respiratory depression

• Relative: asthma (acute), inflammatory bowel disease, respiratory impairment

Chlorpheniramine

• Acute asthma, sleep apnea

Pseudoephedrine

• Hypsesensitivity

• Severe HTN, severe CAD

• Nonselective MAO inhibitors: risk of hypertensive reaction

• Newborns, preemies

Codeine

• Bradycardia, hypotension, tachycardia

• Confusion, dizziness, false feeling of well being, headache, lightheadedness, malaise, paradoxical CNS stimulation, restlessness, weakness

• Rash, urticaria

• Anorexia, nausea, vomiting, xerostomia

• LFT’s increased

• Ureteral spasm, urination decreased

• Dyspnea

• Burning at injection site, blurred vision, histamine release

Chlorpheniramine

• Anticholinergic

• Somnolence

• Constipation

• Diarrhea

• Nausea

• Vomiting

• Blurred vision

Codeine (serious)

• Hypotension, With IV use

• Seizure, With excessive doses

• Anaphylactoid reaction (rare)

• Respiratory depression

Pseudoephedrine

• CNS (tremor, restlessness, etc)

• Insomnia

• Nausea

• Vomiting

Codeine

• Cardiac arrhythmias, drug abuse/dependence, emotional lability, gallbladder dz, head injury, hepatic impairment, hypothyroidism, incr ICP, prostatic hypertrophy, renal impairment, seizures w/ epilepsy, urethral stricture, urinary tract surgery

• Risk of life threatening side effects in nursing babies, especially if mother is an ultra rapid metabolizer of codeine

• Ibuprofen is more effective than codeine for pain from musculoskeletal injuries in children

Chlorpheniramine

• May cause hypotension, with IV use; seizure (with excessive doses), anaphylactoid reactions (rare) or respiratory depression reported

Pseudophedrine

• Mild-mod HTN, cardiac disease, hyperthyroidism, hyperglycemia, BPH, DM, glaucoma

• Many combo formulations are switching to phenylephrine due to restrictions arising from easy conversion to methamphetamine (The Combat Methamphetamine Epidemic Act of 2005 bans OTC sales of cold medicines that contain ingredients commonly used to make methamphetamine such as pseudoephedrine)

• Lactation

Pregnancy category: C

Lactation: codeine, chlorpheniramine and pseudoephedrine excreted in breast milk, use caution